Outcomes of Sleep Disorders in Older Men

描述(由申请人提供)：建议的研究是老年男性睡眠障碍的结果(MROS睡眠研究)研究的5年竞争性更新。MROS睡眠研究旨在通过利用参加男性骨质疏松性骨折(MROS)研究的既定队列，测试几个关于社区老年人睡眠障碍后果的假设。从2003年12月到2005年3月，3135名MROS参与者(100%的目标)参加了辅助MROS睡眠研究。对睡眠的全面和客观的评估(包括通宵家庭多导睡眠监测(PSG)、5天手腕活动监测和自我报告的睡眠质量测量)、心血管事件(CVD)事件的判断以及包括生物样本在内的其他测量被添加到MROS父母研究的扩展数据集中。在最初的周期中，我们确定睡眠呼吸紊乱(SDB)和低氧血症是心血管疾病、心律失常、死亡率和非脊柱骨折的重要独立预测因子。我们现在建议继续跟进MROS睡眠研究队列，以提供足够的力量来确定与SDB相关的特定心血管结果和疾病特定死亡率的风险，而不是综合结果(目标1)。初步发现还将通过测试观察到的SDB/低氧血症与结果之间的关系的几个潜在机制而在更新中得到扩展，包括：i)可阐明机制途径的生化决定因素；ii)肺功能和日间氧饱和度水平；以及iii)客观测量的睡眠时间(目标2)。我们还建议通过对这些疾病进行纵向评估来加强我们的几个与年龄相关的疾病(包括虚弱、身体和认知功能)与睡眠相关的横断面研究结果(目标3)。最后，重复测量PSG和活动描记将使我们能够描述老年男性在5年随访期间睡眠特征变化的模式，并确定这些变化的相关性和后果(目标4)。这次难得的机会是继续对3000多名参与最初一波MROS睡眠研究的男性进行跟踪调查，并重新检查已经贡献了如此丰富数据的队列中的一部分，这将为SDB和睡眠模式与随后的发病率和死亡率之间的关系提供新的见解。公共卫生相关性：睡眠障碍非常常见，尤其是在老年人中。这项名为《老年男性睡眠障碍的结果》研究的拟议更新将为睡眠呼吸障碍、低氧血症和睡眠模式(全面和客观地测量)与随后的发病率和死亡率之间的关系提供新的见解，在一大批社区居住的老年男性中。除了扩展之外，还将探索几种机械途径 后续行动，以便分析更具体的心血管疾病结果和特定疾病的死亡率(而不是综合结果)。

DESCRIPTION (provided by applicant): The proposed study is a 5-year competitive renewal of the study, Outcomes of Sleep Disorders in Older Men (MrOS Sleep Study). The MrOS Sleep Study was designed to test several hypotheses regarding consequences of sleep disorders in community-dwelling older, by taking advantage of the established cohort that was enrolled for the Osteoporotic Fractures in Men (MrOS) study. From December 2003 through March 2005, 3135 MrOS participants (> 100% of goal) were enrolled into the ancillary MrOS Sleep Study. Comprehensive and objective assessments of sleep (including overnight in-home polysomnography (PSG), 5-day wrist actigraphy and self-reported measures of sleep quality), adjudication of incident cardiovascular (CVD) events, and other measures including biological specimens were added to the expansive dataset of the MrOS parent study. During the initial cycle, we identified sleep disordered breathing (SDB) and hypoxemia as significant independent predictors of CVD, arrhythmias, mortality and non-spine fractures. We now propose continued follow-up of the MrOS Sleep Study cohort to provide sufficient power to determine risk of specific CVD outcomes and disease-specific mortality associated with SDB, rather than aggregate outcomes (Aim 1). Initial findings will also be extended in the renewal by testing several potential mechanisms for the observed relationships between SDB/hypoxemia and outcomes, including i) biochemical determinants that may elucidate mechanistic pathways; ii) lung function and daytime oxygen saturation levels; and iii) objectively measured sleep duration (Aim 2). We further propose to strengthen several of our cross- sectional findings relating sleep to age-related conditions including frailty, physical and cognitive function, by performing longitudinal assessments of these conditions (Aim 3). Finally, repeat measures of PSG and actigraphy will enable us to characterize patterns of change in sleep characteristics among older men during 5 years of follow-up, and to determine the correlates and consequences of these changes (Aim 4). This rare opportunity to continue follow-up in over 3000 men who participated in the original wave of the MrOS Sleep Study, and to re-examine a subset of the cohort who have already contributed such a wealth of data, will provide new insights into the relationships between SDB and sleep patterns with subsequent morbidity and mortality. PUBLIC HEALTH RELEVANCE: Sleep disorders are very common, particularly in older adults. The proposed renewal of the study, Outcomes of Sleep Disorders in Older Men, will provide new insights into the relationships between sleep disordered breathing, hypoxemia, and sleep patterns (measured comprehensively and objectively) with subsequent risk of morbidity and mortality in a large cohort of community-dwelling older men. Several mechanistic pathways will be explored, in addition to extending follow-up to allow for analysis of more specific CVD outcomes and disease-specific mortality (rather than aggregate outcomes).